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Individual

MISS IDA THOMPSON PIZZARO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CST/CSFA

Contact information

Practice address
52 BAKER ST, QUITMAN, GA 31643-3657
(229) 263-4827
Mailing address
52 BAKER ST, QUITMAN, GA 31643-3657
(229) 263-4827

Taxonomy

Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
129250
CO

Other

Enumeration date
10/29/2011
Last updated
10/29/2011
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